the eric update - day 58: weight gain. positive negatives and milestones. postcards!

after staying not gaining weight for almost a week after coming off the vent, eric seems to have started adding on a modest amount of weight each day, which is great. tonight's weight-in put him at 1535 grams or 3 pounds 6.1 ounces and he's on 14 cc's of breastmilk every hours. last night they started to double his daily increases in breastmilk from 1 cc to two cc's, by adding a cc in the morning and, if he tolerates the increase, they'll add a second cc in the evening. so, late this evening, he'll get another increase to 15 cc's. since he only needs to be on about 20 cc's every two hours to be considered to be on "full feeds", i think it shouldn't be too long before he's off the intravenous drip entirely, which is great news since the IV line is a great entry point for all manner of infectious agents that we'd like to keep far, far away from eric.

and there's good news regarding eric's direct hyperbillirubemia; the sonogram of eric's liver came back negative for any serious structural defects or major blockages and the first round of liver function tests also came back negative. this means that most of the really bad things that could be causing the condition can be safely ruled out ( well, really only about as ruled out as you can rule out something with a negative result on a micropreemie. remember, the small sample sizes can sometimes give you false negatives. ). given the lack of positive results ( in this case, positive is actually a negative ), the prevailing educated guess is that the condition is "merely" due to changes that occur when you switch back and forth between intravenous feeds and breastmilk, and it should resolve itself after eric goes back on full feeds, which will hopefully be very soon.

today, our neighbor who has 2-year-old triplets who were born preterm, gave us a "preemie calendar" which has a sheet of stickers that you're supposed to put on the days on which certain milestones are reached.

kris and i laughed at some of the ones that we're still anxously awaiting, such as "Moves to Isolette!", "Saw Your Face Without Tape on It!" and "Off Oxygen!" ( you'll probably have to view the large sized image to actually be able to read the stickers ). i'm not sure how i would have reacted two and half months ago had anyone told me that i'd be patiently awaiting for the day i'd see my son's face without a single bit of tape. but, i guess you've got to celebrate the milestone's you have, not the ones you thought you were going to have. or something like that.

in case you were wondering, the postcards are still coming in! i know i'm probably redundantly repeating myself, but i really, truly am appreciate of every single postcard and i can't wait until eric is old enough to understand what it all means.

the eric update - day 57: i come in peace. bearing ( ahem ) gifts.

now that eric isn't doesn't have to endure the sounds of cpap, he can hear quite a bit more of the nicu noise, so it's important to find calming background noise to help block out the ambient sounds.

recently, my sister, candy, sent a bunch of super thoughtful gifts - one of which was this giant bear that makes a woooshing sound when you turn it on. it makes a nice change from the same old music we play to him all the time. we also found necklaces in the box with the symbol for "odin's knot", which is quite appropriate since eric is otherwise known as odin. she also sent a couple of blank postcards with the original odin on the front. oh, and there was also a pair of vans!

it might be awhile before he fits into them, but we'll surely keep them around and get a picture of the event. thanks!.

the eric update - day 57: a nice, quiet day. but liver problems looming?

today was a relatively quiet day, with nary an alarm and only the occasional, normal "desat" ( lowering of the percentage his blood oxygen, which is associated with bradycardia and apnea ) that he seemed to be able to pull out of all by himself. he put on about an ounce and tipped the scales at 3 pounds, 4.7 ounces or 1495 grams; also, he's an astonishing 41.5 centimeters or about 16.33 inches, which means he's added over an inch to his length since the last time they measured him, and he's over 4 inches longer than his birth length!

unfortunately, we discovered that eric's conjugated or "direct" bilirubin levels are rising, which is cause for some concern and eric will get increasingly jaundiced, if the cause is not discovered. it might sound like eric is just having another bout of the physiologic jaundice that all babies can get which can be fixed by phototherapy, but unfortunately things are not that simple.

the two types of jaundice have different causes and different treatments. the good news is that we're probably seeing the result of eric's liver getting "sludgy" ( the neonatal nurse practitioner's term, i swear ), which is not too uncommon after switching back and forth between intravenous feeds and breastmilk ( which is what has happened to eric ); if the cause really is eric's sludgy liver then we can expect the issue to resolve itself after he gets back on full feeds. but there are also many other less fun things that can cause higher levels of conjugated bilirubin and they are currently trying to rule those out. he'll have an ultrasound of his liver sometime during the night and they drew a bunch of blood for a panel of liver function tests, but we won't know the results of those tests for a couple of days.

if it's not one thing, it's surely another in the nicu.

the eric update - day 56: eric's second lunar birthday!

thankfully, eric's alarms stopped alarming and everyone feels quite confident that the whole hullaballoo was just eric's way of saying that he needed a little more help breathing that we thought. without the constant alarms, we were able to enjoy a relatively quiet 8 week birthday. eric's friends all gathered around to wish him a very happy birthday. after eric was finished socializing, i had the chance to give him his very first "spit bath"! it took me a little longer than kris takes when she gives him a bath, but we eventually made it throught he process relatively unscathed.

kris will claim that she doesn't know how to take nice photos, but i think this series proves that she's fibbing.

clinically speaking, eric is doing very, very well, which is amusing to say considering all the alarms just yesterday. he's tolerating his feeds as well as anyone could expect and the amount of undigested material that they are pulling out of his stomach between feeds is gradually diminishing. i think that it might be possible for him to be back on full feeds by the end of the week. he's looking a little pallid due to a gradually decreasing number of red blood cells. so, despite the hope that he might have recently had his last transfusion, it looks like he might get one ot two more.

i haven't been giving any updates on his weight because he hasn't been adding on any weight. i discovered that being on the vent is a great way to add weight to a micropreemie, since it's doing all the work and they can convert the extra energy towards gaining weight. since eric's not on the vent, it's not unusual for him to stop adding weight as quickly as he had been; however, i think they'll look at adjusting his diet a bit in the coming days, since it's not a good thing to not put on any weight for five whole days.

we always know that odin's lunar birthday is approaching because it coincides with the full moon. well, technically, it's a day after the full moon, but it looks full enough to me. i realized tonight that i hadn't bothered to capture a photograph of the moon 4 weeks ago, and i couldn't let it happen again.

it's seemed like a big, bright birthday candle in sky as we took the dogs for their nightly walk.

the eric update - day 56: the fourth. part six.

aha! i tricked everyone and released two movies in one day. introducing, 'the fourth. part six' ( 'the fourth. part one.' 'the fourth. part two.' 'the fourth. part three.' 'the fourth. part four.' 'the fourth. part five.' ).

cat stevens' "morning has broken" provides the soundtrack for 'part five'. once again, matthew moroz came through and suggested a song that i think works quite well. hopefully you'll think so too.

it's hard to believe that if you watch 'part five' and 'part six' in succession, you'll be seeing a full month of eric's growth in less than 10 minutes. enjoy!

the eric update - day 56: the fourth. part five.

woohoo! eric is 8 weeks old, which means it's his second lunar birthday! to celebrate, i thought it was about time time to release the 'the fourth. part five.' ( 'the fourth. part one.' 'the fourth. part two.' 'the fourth. part three.' 'the fourth. part four.' ).

after i released 'part four', i decided that it would make my life easier if i released movies every two weeks, instead of every week, but 'part five' sat in postproduction for two more weeks, for no good reason other than a lack of time and energy to put the finishing touches on it. so, that's a long way of saying the 'part five' covers weeks 5 and 6 and does not include photos from the past two weeks. as you might guess, 'the fourth. part 6.' is being edited down and will bring the series up to the current date.

i ended up going with another tuck and patti song, which i tried to avoid, since i had already chosen them for 'the fourth. part two.' and everybody knows that the rules dictate that you can't use material from the same artists for more than one track when you're doing this sort of thing; but after trying lots of other songs, i just couldn't get their rendition of cyndi lauper's "time after time" out of my head, so i relented and went with it. i think it's just about perfect and hopefully you'll forgive my breaking the rules associated with picking soundtracks.

i didn't get a lot prerelease feedback on the tearability factor, but my guess is that you might want a tissue or two within reach just in case.

the eric update - day 55: please keep your seatbelt tight and your hands safely inside the car.

today was quite exhausting, but in the end it might hopefully be best remembered as eric's first, big false alarm. he started "alarming" ( meaning his breathing stopped and his heartrate would drop to dangerously low levels ) suddenly over the prior night and he kept it up through the morning. protein showed up in his urine which normally might not cause immediate concern. but it could possibly indicate a blood infection; taken with the increase in alarms, and his previous history of "crashing" fast, the staff went into "red alert" mode and started running tests to try to narrow down what was going happening. ( in this photo, eric is remaining remarkably calm, despite having a bag taped to his groin to collect urine for a more extensive analysis. )

coincidentally, eric's neonatal nurse practitioner was also on duty during his prior two "crashes" and made it clear that she was being hyper-vigilent. in a sense, it was reassuring to know that someone was watching his every move who was intimately aware of his ability to crash suddenly and without many of the normal warning signs ( trouble digesting food or bad blood gasses or immune cell counts ). she talked with us for quite some time about how strong a fighter he was, but that it can be more difficult to know how to treat him; unlike a "wimpy white boy" who will wear his ailments on his sleeve, he fights and fights and fights and looks fine, until he can't fight anymore and crashes fast.

when we talked in the morning, the n.p.p becky was leaning towards the theory that eric was suffering from a bug that wasn't responding completely to his antibiotic treatments. looking over his record, she thought she could see a pattern of getting sick 4 or 5 days after being taken off antibiotics. by noon she was so convinced of her theory that was prepared to start him on "big boy" antibiotics ( the nurses term for antibiotics which are reserved for treating the nastiest of the nasty bugs ) even without any strong evidence that he had an infection.

in the end, after hours of alarms and lots of theories about what may or may not be happening, they decided to turn up the rate of air flow on his nasal cannula and he stopped all of his "naughtiness" ( nurses term for when babies alarm ). it's impossible to describe what it's like to spend the day trying to muster the energy to yet again prepare for the worst, only to things quiet down after fiddling with knobs.

a false alarm? we'll know more if he makes it through the night without any more problems.

after the staff turned up his flow, he start to get less listless and more active ( a good sign, since turning into the equivalent is one of the possible signs of an impending infection ).

as we prepare to leave for the evening, eric decides that he's ready to bust out of the nicu and attempts to wiggle off the radiant warming bed.

the eric update - day 54: his first "onesie"! and non-nutritive suckling!

eric's intravenous line was moved to his foot, so we were able to dress him in his very own cloths today!

pooh and piglet came over to check out his new duds and compliment his on being healthy enough to ditch the hospital outfits. pooh is particularly amazed at how big eric is getting, while piglet is confused as to why the bears on eric's shirt don't look like pooh bears. we received the shirt from beth, a friend of kris' who also recently had a preemie in the nicu ( thanks! ). i believe the shirt can be found at target and is one of the few preemie specific outfits that they carry in the store. it's a little hard to tell from the picture, but he still has plenty of room to grow in clothes, which is funny because they look so tiny compared to full-term baby outfits.

today, we reached a milestone that nicu veterans probably suspected was fast approaching when they saw the supersized paci. that's right, the sometimes long and complicated process of getting a micropreemie to breastfeed has officially begun with what's known as non-nutritive suckling. essentially, after kris has pumped ( charming phrase, no? ), she puts everything in place while eric gets a feeding through a tube. it's the first step towards getting eric to realize that food doesn't always come from a syringe; despite the fact that no feeding takes place, it has innumerable good side effect, from aiding in mama and baby bonding to helping kris to sustain her milk production. it's not unusual after 6 or 8 weeks of pumping for milk production to begin to fall off if real breastfeeding hasn't begun, so it's time to start trying tactics to keep production up, since even if everything does optimally well, it could be weeks before eric is able to coordinate the complicated series of events that need to occur for proper breastfeeding.

the eric update: media matters

we're getting more new visitors than ever. odin's adventures were mentioned in article on blogging in a spanish language periodical. i can make out the basic details of the quote, but i'm not going to embarrass myself with trying to produce an interpretation :-)

and daddytypes picks up on the ugly doll product placement opportunities. why stop with the ugly doll?

i'm still waiting for the checks from pampers and johnson & johnson.

the eric update - day 53: supersized paci. yet another spit bath. first laundry load!

tonight, eric was upgraded to a really, really big paci, which is yet another sign that he's getting to be a Big Boy. the pacifier is a special preemie, orthodontically-correct paci which the nurses claimed would be difficult to find outside the nicu. it doesn't seem too difficult if you know where to look, but maybe there's a difference that makes a difference that i'm not seeing. i'm sure someone can help me clear up the confusion. in any case, the supersized paci is a big step on the way to getting prepared for breastfeeding. it's neat to see him start to suck on everything in sight when it gets close to feeding time, even though his feedings are coming through the feeding tube.

maybe someday, i'll stop documenting every bath that he gets, but today was not that day. kris looked at me with a raised eyebrow when i told her that i was going to photograph yet another spit bath, but i just couldn't quite bring myself to not take the pictures. hopefully you'll still enjoy the fruits of my obsessiveness.

in one of the most subtle changes of late, eric's nasal cannula air flow was decreased from 2 liters to 1.5 liters, which is a huge step forward in the process of getting weaned from the respiratory aid. the nurses thought he'd need to have his supplemental oxygen turned up to help offset the decreased airflow, but he didn't, which they said was quite impressive.

the floating ball indicates the flow rate. when it gets to zero, he'll be able to get rid of the nasal cannula altogether and be free of tubes up his nose!

they also told us that, as soon as he gets the IV taken off of his hand, we can start bringing in his own personal clothes! the clothes he's wearing now are special tops with velcro that make it really easy to get on and off in the event of an emergency, but soon he'll be able to wear regular street cloths.

so, late in the night we did his very first load of laundry.

the eric update - day 52: still more postcards and gifts! and progress, micropreemie style.

today was another quiet day of making slow, steady progress. he's increased his breastmilk feedings to 8 cc's every two hours and appears to be continuing to tolerate them well. they will usually pull out up to 3 cc's of undigested food before each feeding, but that amount doesn't seem to be increasing as they up his total feedings, which is a good sign that his digestive system isn't slowling down.

if he continues to tolerate the "bolus" feedings ( where they give him the breastmilk all at once, instead of a "continuous feed" where the milk is pumped in at a constant rate ), then they'll keep adding a cc to the amount that they're giving him every two hours. so tommorrow, i'd expect him to be on 9 cc's every two hours. and given his wieght, he'd need to be getting about 20 cc's every two hours to be on full feeds again ( meaning no additional parenteral nutrition from the IV ), which means he could have an intravenous line in for a ten days to perhaps two weeks. he's having a little bit of trouble keeping a good IV and i think they might be running out of nice big veins; i suspect that sooner rather than later they might be forced to put the line in less attractive locations like his scalp.

we got some more postcards! and we've received lots and lots of gifts lately, from friends family and strangers, and i just haven't had time to properly acknowledge them. i'm going to put pictures of everything up as soon as i get the free time, but in the mean time, please know that we've enjoyed everything we've received and are continually amazed at the new suprised that the mail seems to bring each day.

the eric update - day 51: saying goodbye to cpap. rumors of an isolette.

woohoo! he's on all nasal cannula, all the time! and not alarming at all. o.k. he still has the occasional apnea or brady, but they're all for reasons that don't particularly concern the staff. he's on 7 cc's of breastmilk every two hours and tolerating it well - not great, but not bad either. Every so often they'll pull a few cc's of undigested milk out of his stomach before they introduce the new milk; if the amount that they pull out increases then they'll slow down his feedings.

so, day 51 was a very, very good day. and there are whispers amongst the staff that, if he keeps up keeping up, then he'll graduate to an isolette and ditch his radiant warming bed! amazing!

the eric update - day 50: eric's first tub bath! and even more nasal cannula.

the big news today was that eric got to have his first tub bath after weeks of "spit baths" with a washcloth. micropreemies are often none to impressed with bathing, as it just makes them cold, so it's interesting to see his reponse. at first he seems like he might get quite unhappy with with the whole bathing thing, but he eventually settled in an waited patiently for it to be over. all the bathing was quite tiring, so after playing with a new toy that kris bought, he looked around for a bit and quickly fell fast asleep.

he's up to 8 hours of nasal cannula, followed by 2 hours of cpap and handling it wonderfully, with very few alarms. i'd expect them to test out 24 hours of the nasal cannula very soon.

he's still having trouble digesting the breastmilk as quickly as they'd like and he'll typically have an alarm or two after feeding. the alarms after feeding are from the weight of the food in his stomach pressing on his vagus nerve, which helps to maintain his heartrate. the fact that his food isn't moving along as fast as they'd like is aggravating the situation. at this point, there's not much they can do, except watch him closely and obey the signs that he's sending to take it slow with the feedings.

the eric update - day 49: eric's 7 week birthday!

let's all give odin a little birthday cheer, as it's his 7 week birthday today! he gained a few grams and is now solidly in the 3 pound category at 3 pounds and 3.5 ounces. he also added a half a centimeter and is 38.7 centimeters or 15.25 inches, which means he's added 3.25 inches to his length in the past seven weeks! woohoo! he's rapidly being weened from the cpap and is on 6 hours of nasal cannula and 4 hours of cpap. since he's doing so well breathing on his own, i suspect that within the next few days they'll see if eric can go 25 hours on the nasal cannula. despite having to do more breathing on his own than ever, he's throwing very few alarms; he only seems to alarm when the nurses are doing their "meanies" or when he's put his head in a position that's not conducive to breathing. his breastmilk feeds stayed the same as yesterday, as they're pulling up more undigested food than they'd like to see, so they're going to back off a bit on increasing the amount of milk that he's receiving. you might remember that anytime digestion slows and milk starts hanging around, there's an increased risk for a gut infection, so they're just going to take things slow.

the nasal cannula needs to be taped on his face to reduce the chance that he'll pull it out and the process of repeatedly removing the tape when he goes back on cpap has made his skin a little raw. tonight, he even has a tiny bit of flesh pull away, which he obviously didn't care for at all; nurse peggy put little pieces of what's known as comfeel on his face to prevent it from happening again because open, irritated sores are not a good thing when you're enduring a prolonged stay in the nicu.

eric's getting much better at coordinating his sucking and breathing; a mere week ago, he'd alarm when a pacifier was in his mouth for more than 15 or 20 seconds, but now he can keep the pacifier in as long as he'd like. since he's doing so well, nurse peggy said that it's a good time to introduce a pacifier during his breastmilk feedings so he can begin to associate sucking with feeling of food in his stomach. this is but the first step in a long process of getting his used to having to coordinate the sucking, swallowing and breathing that must occur for real breastfeeding, so it's a big step.


sometimes he has trouble keeping the pacifier in his mouth with the tubes in the way, so peggy has "illegally modified" the paci by notching it so that the tubes can stay where they need to stay and he can more easily keep it in his mouth. nurse peggy is thoughtful like that.

the eric update - day 48: gifts! last transfusion? no alarms (except pops induced)!

there's no doubt about it. we're back to the ho-hum days that are mostly filled with kangaroo care.

eric is being transitioned from the cpap to the nasal cannula much more quickly than previous attempts. today, they altered his schedule to alternate between 4 hours of cpap and 4 hours of the cannula. amazingly, he only had 2 brady's (bradycardia, or slowing of his heart rate ), the entire day and both were while he was on my chest, which, of course led to endless jokes from kris and nurse jan. both brady's were due to his head slowly getting into a position that made it difficult for eric to breath. of course, whenever eric's on my chest he seems to enjoy putting his head in the position that will lead to a brady. i imagine that he thinks it's a fun game to have me move his head in the correct position, only to move it slowly and imperceptibly back to the wrong one. over and over we play the game and sometimes he wins and has a brady.

eric also likes to tug on his nasal cannula, pulling the prongs out of his nose. if he weren't doing so well breathing on his own, we'd know when the prongs were out of his nose, as his blood oxygen levels would start to decrease. but since he is breathing so well, we don't see the "desat" and only later discover that his prongs have been out for as long as 10 or 15 minutes at a time, which is yet another sign that he's getting stronger.

some longtime friends, matt and erin, who we haven't seen in awhile came into town this weekend bearing gifts! eric was happy to receive his new ugly doll, even if the nurses were all a little perplexed as to what an ugly doll was and why on earth anyone would want to buy one. but we don't care what they think, since eric and the ugly doll got along quite famously and found themselves in long, heated discussion about which of them was taller. clearly, the ugly doll has no grounds for his assertion that he is, in fact taller than eric.

in addition to giving him the ugly doll, they also gave him a cap that erin knitted with her very own hands! the nurses were all very impressed that the cap was knit by a nicu rookie, since it can be tough to make the cap snug, but not too snug, and it should also be quite stretchy in all directions to accomodate the various forms that his very malleable head might take on from day to day. there's a bit bucket of "discards" in the waiting room outside the nicu that have been knitted by volunteers but that haven't passed the quality control inspection from the nicu staff, but eric's cap won't be in it, because it's about as perfect as you could want it to be. thanks!

there's nothing special about the fact that i'm changing eric's diaper, but i couldn't remember ever providing photographic evidence to dispute any lingering suspicions that i might be trying to shirk diaper changing duties. it's a bit more tricky to change his diaper these days, since it is seemingly impossible to not get the velcro on the diaper stuck on the shirt before you get all the cords and lines out of the way. as i change his diaper, it strikes me that as odd to think that some day we'll actually change his diaper and not have to worry about pulling out IV or feeding lines or detaching sensors.



it occured to me that i've only casually mentioned his intravenous feeding and having discussed at greater length a very important element of how well eric is doing. so it's time for a short course in parenteral nutrition, where parenteral refers to food that enters the body through a blood vessel. in what is known as total parenteral nutrition, all of the essentials ( carbohydrates, protein, fat, vitamins and minerals ) are delivered directly through an IV line in one of eric's veins. despite all the active research that has gone into parenteral nutrition and fact that it's probably one of the greatest reasons that eric has been able to keep growing despite suffering from pneumonia, i can't help but feel that the bag of fluids look suspiciously like gatorade and the the syringe surely must be filled with lard and not some state of the art blend of short chain lipids as they claim

eric received three more transfusions today which brings him to a grand total of 17 thus far. he needed the transfusions because he still has a hard time making new blood as quickly as he breaks it down and they're talking a lot of samples out to keep close track his immune blood counts while he has pneumonia. we were told today by nurse jan that, if things went as they expected, today's transfusions would be the last he's likely to receive during his stay in the nicu!

it's interesting to note that while we were free to explore giving "directed donations" ( where we give the blood that eric would receive ), we didn't because it apparently takes so long to process and screen the donations that they often get the donations back after they are no longer needed. also, the screening criteria for neonatal donations is so rigourous ( i.e. can't have any antibodies for many common ailments ) that it's often difficult for the parents to pass the screening test. so while the staff would never prevent us from giving blood, they've always strongly hinted that it's easier, safer and faster to just get transfusion from their trusted pool of special neonatal donors.



because they have to monitor his blood pressure and other vitals closely during the transfusion, there's no kangaroo care to be had during the process. of course, kris wasn't going to let let three transfusions get in the way of lots of kangaroo care, so she simply had to time the sessions differently than normal. speaking of timing, while you might think that we can just waltz into the nicu and do the 'roo, in addition to having to work around the transfusions, we also have to be aware of the nurses rounds which occur every two hours. and it's also nice to get the kangaroo care in while he's on the nasal cannula as the cpap mask can have a hard maintaining a good fit while he's doing the 'roo. so there's quite a few "knowns" that we have to deal with in addition to the usual array of "unknowns", such as getting kicked out abruptly in the evening, just after kris had settled in with eric, to prepare for two new admits.

the eric update - day 47: 3 pounds! no ROP ( yet )! the return of the nasal cannula!

wow! a mere 16 days after hitting 2 pounds, eric weighed in at 1370 grams tonight! or 3 pounds 0.3 ounces! it's absolutely stupendously amazing that he's gained a whole pound in such a short time, especially when he's been so sick. i guess he really does have the snowdeal genes, since putting on weight has never really been a problem for generations of snowdeal men. it's amazing to see how quickly his appearance is changing on a day-to-day basis with the weight gains.

eric is also getting 4 cc's of breastmilk every 2 hours. he has a long way to go to be considered on "full feeds", as he'd need to be getting about 19 cc's of milk every two hours before they'll discontinue his IV completely. still, he's making great progress and seems to be tolerating the milk quite well.

and he has a mere 2 days left on his antibiotic regime to treat the pneumonia and suspected sepsis. interestingly, after all the hullaballoo surrounding the sepsis it appears that the gram negative stuff they found in the yeast culture was likely a contaminant. i guess that's the way it works sometimes.

also, the eye doctor came by for his regular ROP checkup and didn't detect any sign of abnormal blood vessel growth in his retinas. while this is great news, the doctor felt the need to warn us that not only was eric not out of the woods - he wasn't even in the woods yet! now that's some smooth bedside manner. he then stated matter of factly that eric's most vulnerable stage will be between 33 and 39 weeks and that most 24 and 25 weekers will develop stage I or stage II of the condition. so, once again, while we're extremely happy that his eyes are fairing well, his next few checkups will be the ones that will really give a better idea of if he'll develop ROP.

and just as we suspected, they've started testing eric out on the nasal cannula again, with 2 hours of nasal cannula, followed by 6 hours of cpap. and despite my many attempts to miminize the appearance of one of the side effects of the cpap mask, sometimes it's impossible to hide the conehead that he can get from the tight cpap straps pushing against his very soft head.

he seems to be tolerating the nasal cannula very well and is continuing his streak of remaining alarm free! that's right - he hasn't had a single incidence of apnea or bradycardia. it really is hard to believe that he's showing such great improvements in such a short period of time. i guess it's hard to remember that things can get better just as quickly as they can turn for the nurse. such is the way of the nicu.

the eric update - day 46: many more postcards. no alarms (almost). and a little 'roo time with pops.

well, it looks like we're back to having days where the biggest news came when we received 16 postcards all at once! i had joked with the staff yesterday that perhaps the mailroom got sick of running his cards up to the nicu and maybe there was a kernel of truth in the joke, since some of the postmarks were from 8 days ago. regardless, we finally did get them all and we'll enjoy reading them to eric over the next few days. thanks again to everyone two has taken the time to send a card ( or two, or three! ). as always, it makes our day that much more special to be able to read eric postcards from all over the world.

clinically, eric had a - thankfully - boring day. i forgot to mention that he didn't have a single alarm yesterday and he would have kept the streak going today had it not been for a tantrum after his "eight o' clock meanies". at eight p.m. his nurses do the various things that nurses have to do and tonight he let us all know that he was none too happy with the situation. he got really mad and when he gets really mad he'll decide that breathing isn't too high on his priority list. the nurses have come to expect eric to be "naughty" ( a common nurse euphamism for when babies are being uncooperative ) at such times and don't really count it against him on his permanent record.

eric is getting three cc's of breastmilk every two hours and if he keeps tolerating the milk, i think it's reasonable to expect that he'll be back on "full feeds" ( meaning no intravenous fluids ) by the end of the weekend or early next week. obviously, with his gut shutting down last week, they are monitoring him very closely for signs of necrotizing enterocolitis. so far, all signs indicate that he's tolerating the feeds quite well.

eric's hands and feet were looking a little puffy, which partly can be explained by water retension as a consequence of the intravenous drip. however, his hands looked very puffy and likely related to relatively minor issues with his IV line. due to a variety of reasons he's been having troubles with the line being put in his hands so after trying a few different locations on his hand they decided to move the entry point to his foot. in the end, they found a spot that seemed to agree with him, but not after leaving a few battle scars on his hands.

in addition to 2 hours of kangaroo care with kris, i remembered to wear an appropriate shirt, so i was able to spend about an hour of quality time with eric, doing the 'roo.

and finally, kris gave eric a brief bath today without his cpap mask ( meaning he didn't have any respiratory aid ). he didn't throw a single alarm and his blood oxygen looked great, which prompted his nurse to make a clinical note that they might want to think about putting him back on the nasal cannula ( the nasal cannula requires more work on eric's part than cpap and is considered to be the last phase of "assisted" respiration ) sooner than they originally planned. woohoo!

hacked account? strange post deleted.

there used to be a post here that i didn't post, which is worrisome to say the least. a flaky internet connection and a hacked account? time to change the password, me thinks for the blogger account.

sorry for the confusion.

the eric update: Tiniest baby thrives as teenager

there's small and then there's really, really, really small. madeline was born in 1989 at loyola university medical center ( which at least one reader and frequent commenter ( :-) ) is quite familiar with ) at just 280 grams or 9.9 ounces. having such a small birthweight at her gestational age would normally lead on to believe that she might be headed for complications down the road. but apparently the tiniest baby every to survive had other plans:

"But 14 years on, Madeline is remarkably healthy, Muraskas and his colleagues report in the New England Journal of Medicine1. She is small for her age, at only 136 centimetres compared with the average 163 centimetres, but she is in the top 20% for high school entrance exams scores. "I think her development is a miracle," Muraskas says."

don't get me wrong, i'm comparing eric to madeline or anything of that sort - just recognizing the accomplishement :-)

don't get me wrong, i'm not comparing eric to madeline or anything of that sort - just recognizing the accomplishement :-)

interestingly, madeline's mom had preeclampsia, which is what thrust us into our little adventure.

the eric update - day 45: off the vent! kangaroo care! first shirt! doubled weight!

wowza. so many good things happened today that it's going to be hard to summarize them into an easy to digest nugget. after eleven long days on the ventilator we were quite surprised ( as were many of the nurses ) that the neonatologists decided that eric was ready to be free of the vent. apparently his right lung looked much better than anticipated after this morning's x-ray and the doctor's decided that he was recovered enough from pneumonia to give the cpap a try. woohoo! and you know what that means - we can hold him again! here, nurse peggy is handing him off to kris for a little kangaroo care.

despite getting the great news that he was back on cpap and therefore able to be held, everyone thought that he would only be able to stand small amounts of kangaroo care. nurse peggy watched his stats carefully after the transfer for 5 minutes. then 10. then 15. and 20. until she finally decided that eric was doing better off the vent than on. he did spectacularly for an hour, with not a single alarm, and he was only put back in the radiant warming bed when kris decided that she had to go pump breastmilk. it was quite and accomplishment as he's still has pneumonia. his breathing was as stable as you could ever want it, which is impressive because babies can sometimes get lazy after being on vent, as the machine does much of the work for them. after an hour of kangaroo care from mama i was able to hold him "regular style" ( i had no idea that he'd go off the vent today so i didn't wear clothing appropriate for kangaroo care ) for a half an hour. fun! (

as if all the great news about him getting off the vent and getting kangaroo care wasn't enough to absorb for one day, nurse peggy announced that he'd be getting his first shirt! it's a sign that his caregivers think that he's getting more stable than ever, since it means that they aren't so preoccupied with having to see how mottled or flushed his skin is at any particular moment. i picked a very stylish blue pinstriped top.

and last, but certainly not least, eric hit a big milestone today by officially doubling his birthweight. he weighed in at 1335 grams or 2 pounds 15.1 ounces!

it's hard to believe that he only needs to gain about an ounce to hit 3 pounds. it seems like just yesterday that we were celebrating the 2 pound milestone. gaining so much weight while fighting pneumonia is an impressive feat. they grow up so fast!

wow! wow! wow! after eleven days of hardship, it's really exciting to have to much good news to report.

the eric update - day 44: almost closed pda. bugs? and more bugs?

i think eric is enjoying dragging out the drama of doubling his birthweight. he was up 10 grams today, topping the scales at 1270 grams or 2 pounds 12.8 ounces.

we finally received word on his patent ductus arteriosis and it's almost amusing - it's not closed, but it's not open wide enough to warrant additional measures to try to close it. although everyone seemed quite confident that it would close on its own, it's still slightly disconcerting to not be able to give a definitive answer to the innumerable questions regarding the status of the hole in his heart. i didn't follow up as rigorously as i might normally as to why they weren't going to pursue another round off indomethacin simply because everyone seemed so confident that the hole wasn't big enough to have any physiological consequences and that it would close on it's own accord.

unfortunately, i don't have any good an answers as to what may or may not be the source of his sepsis ( if, in fact, he does have a blood infection ). remember, they caught a gram negative bug in a blood sample that was being used to determine if he had a yeast infection. they've been having trouble determining the exact type of bug in the sample because, as a person from "infectious diseases" said today - "fungus is funky". in other words, they are trying to grow enough of the bacteria to allow identification in a media that was meant to grow fungus and it's not working well. all you armchair microbiologists in the crowd could perhaps speculate as to why they can't transfer the small amount of the bacteria they did find into a more suitable media. then again, i might have some of the details confused so it might not be worth your effort. luckily they haven't found any bugs growing in any other samples they've drawn, so all this might be much ado about nothing.

we also received the results from another round of "trach aspirate" tests, which indicate if he has anything growing in his trachea ( being intubated on the vent greatly increases the chances that strange bugs will grow in his trachea ). six days ago, they discovered small amounts of enterobacter and klebsiella growing in his trachea and today they said the bugs were still there, despite being on antibiotics for nine days. the staff seem to not be overly concerned about the bugs sticking around for now. things might be different if they are still there after they finish the antibiotic regime, which will last for about 6 six more days.

oh. and his arm was quite red around the entry point of his IV line, which would strongly indicate that a superficial bacterial infection was starting. they moved the line and applied a topical antibiotic which will hopefully prevent any further complications.

i was joking with the nurses that i didn't have any of these problems with bugs when i was a 26 weeker, 32 years ago, and that one couldn't help wonder whether or not eric IV had the misfortune of finding himself in a "dirty" unit ( really, it was all in good humor ). aside from being continually astounded that i survived the ordeals of being a micropreeming in 1972 ( indeed, one nurse commented that when she started in the nicu at about that time, they would have never tried to save a 28 weeker, little less a 26 weeker ), the nurses all remind me that we can thank indescriminate usage of antibiotics for causing all the "bug" problems that are seen in the modern nicu.

so think about the micropreemies the next time you jump for the medicine cabinet to grab an antibiotic for a minor ear infection.

the eric update - nicu noise.

now that eric isn't on cpap, he gets a brief respite from the constant din of the whitenoise produced by the air rushing through the mask; the unfortunate side effect is that he can hear all the other sounds of the nicu just that much better.

although it was difficult to do, i think the representative minute of nicu noise inthe movie is perfectly average. sometimes it's quieter and sometimes it's noisier. much noisier. after 30 seconds of relative quietness, it really starts to pick up in decibels. of course, all of the different bells are indicative of different things, such as a IV drip running dry, or an apnea or a vent tube being blocked. none of the alarms in this clip were produced by any of eric's equipment.

you can get the greatest sense of "being there" by putting on a set of headphones.

the eric update - day 43: readin', feedin' and noise.

another day of quiet recovery, which is a good thing these days. slightly frustratingly, we still haven't heard the results from the echocardiogram which will tell us if his patent ductus artierosis has closed, but his blood gasses are so good that i think everyone is assuming that it's closed. also, they are apparently having trouble determining what the bug was that showed up in one of his blood samples and haven't been able to find any more of it, so it's likely that we'll never know for now if it was contamination or is simply lurking in the background at undetectable levels while he's on the antiobiotic regime. or maybe it's gone for good.

they started eric's breastmilk feedings again, which means that they are getting more confident that he's recovering from his recent "troubles".

technically, they aren't really feedings as they are giving him such a small amount - only 1 cc every 3 hours, but it's a start. rather than sending the food directly to his intestines via an "o.j." ( oral to jejunum ) tube, they've decided to see if he's can tolerate sending the milk directly to his stomach via his "o.g." ( oral to gut ) tube. this is another small sign that they believe he's getting stronger, despite his pneumonia.

the nicu is packed these days and when it gets packed it gets noisy. it's a small nicu with only 15 beds, but it's a small space and can get quite crowded when all the beds are filled, if all the babies have visitors. there's and ebb and flow to visitors and during peak hours it the constant din of conversation and bells ringing can make it sound like a surreal cocktail party.

if you're paying attention when it's noisy, you'll notice eric sending little signs that things are getting too loud, such as grasping his ear tightly in an attempt to block out the sound. subtle signal, no?

kris finished reading eric jonathan livingston seagull. he liked it a lot.

"poor fletch. don't believe what your eyes are telling you. all they show is limitation. look with your understanding, find out what you already know, and you'll see the way to fly."